Evaluation of results of anabolic steroid injections in treatment of delayed union and non union of long bone fractures

Author(s): Abhijit More, Vivek Dubey and Nandan Marathe

Abstract: The long-term complications of fractures both with or without treatment include delayed union, malunion, nonunion, infected non-union. Nonunion of the long bones fractures is a serious complication prolonging patient morbidity, time lost from work, and economic burden over family. Patients with non-union have significant disability and costs to the patient. Direct evidence of bone formation by Nandrolene Decanoate was given earlier by many. Anabolic process of protein synthesis, with new tissue formation, requires the action of anabolic hormones. Exogenous administration of these agents has been shown to maintain or increase lean body mass as well as directly stimulate the healing process through their anabolic and anti-catabolic actions. Our study aims to study efficacy of anabolic steroids in healing of non-union of fractures and recovery in delayed union. Patients in the age group of 20-80 years with confirmed clinical and radiological diagnosis of delayed and non-union and ready for follow up visits on regular basis were selected for study. Patients were thoroughly evaluated and assessed. Patients included in study were given intramuscular injection of Nandrolene Decanoate 50 mg once in every three weeks. Total period for administration of injection was 6 months with patients follow up at 3^rd, 6^th and 12^th month. We studied 44 cases in the period of two years from December 2015 to December 2017. We found that transverse fractures (40%) commonly undergo non-union. In our study, 35 patients were managed with operative (79.5%) and 9 patients were managed with conservative management (19.5%). Twenty six cases (59%) had delayed union and 18 were of non union (41%). In our study the number of doses given to patients were between 3 to 7. In our study, 28 patients showed good results (63.6%), 4 showed satisfactory results (9.1%), 6 showed excellent results (13.6%), 6 showed no response (13.6%). In patients with application of RUST criteria for union, we observed gradual rise in accordance of healing of fracture with pre-treatment mean RUST value of 4.9, within 3 months of treatment RUST rose to 7.2. At 6 months of treatment mean RUST value was 9, and after 12 months mean RUST was 10.5. These observations were consistent with callus formation in our study. We concluded that delayed union and non-union of long bones can be treated conservatively. Patients treated with Nandrolene Decanoate 50 mg intramuscular once every three weeks showed positive results. This avoids multiple operative procedures like bone grafting. Multiple hospital admissions and long hospital stay was also avoided as patients were treated on OPD basis. Our intervention can be considered as a simple and short treatment course with satisfactory results reducing the economic burden on patients and their family. Nandrolene Decanoate can be considered a valid, economical and a non-operative alternative for patients of delayed union and non-union.

DOI: https://doi.org/10.22271/ortho.2019.v5.i1c.21